ZocdocAnswersWhy would I have enlarged lymph nodes?

Question

Why would I have enlarged lymph nodes?

A recent MRI showed an abnormally large number of lymph nodes in my neck. What could this mean? I have headaches and was referred to a neurologist by my primary physician. The neurologist ordered an MRI of my head and neck as well as an EEG to rule out anything more serious before settling on the diagnosis of migraines. I was also recently diagnosed with mixed connective tissue disease and am taking plaquenil. I was referred to an ENT and have an appointment in a week.

Answer

Sorry to hear that you have been having such bad headaches, and that you had an MRI of your head that incidentally found enlarged lymph nodes in your neck. As you are probably aware, there are hundreds of lymph nodes in your neck. Lymph nodes are part of your lymphovascular system that collects fluid that leaks out at the junction of your arteries and veins at the tissue level. Lymph nodes have immune cells within them, and when something is identified that causes an immune reaction (like a virus), the lymph nodes will get larger due to activation and hypertrophy of immune cells. There are systemic effects from autoimmune disorders (which can be part of some connective tissue diseases) that can cause lymph node swelling. There are numerous other causes of lymph node hypertrophy; if there is an infection in an area that the lymphovascular system is "draining", those lymph nodes can be swollen. Also, lymph nodes can at times act like "filters" when there is a cancer in the body. If the cancer has individual cells that break free into the lymphovascular system, they can be caught in the lymph nodes. If they grow in those particular lymph nodes, they will be larger and continue to grow. This is called "lymph node metastasis". I don't want to scare you, because there are other reasons for having lymph node swelling, but I wanted you to be aware of some of the serious causes. It sounds like you are on the right track going to an ENT to get checked out. They will do a thorough exam, take a good history, and go through your MRI with you to help determine why there is swelling of the lymph nodes. I recommend trying to get a copy of the MRI (on CD) that you can take with you to your ENT appointment, because it will be helpful for them to look at the actual film and not just the "read". Best of luck.

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